Healthcare Provider Details

I. General information

NPI: 1699415067
Provider Name (Legal Business Name): GABRIELLE RIVERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HWY
JEFFERSON LA
70121-2429
US

IV. Provider business mailing address

200 HENRY CLAY AVE STE 2000
NEW ORLEANS LA
70118-5720
US

V. Phone/Fax

Practice location:
  • Phone: 866-624-7637
  • Fax:
Mailing address:
  • Phone: 504-988-5458
  • Fax: 504-988-6808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number349501
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: